Overnight Health Care: Paul Ryan to exit without entitlement reform | NIH investigates funding for alcohol study | Doctors push back on opioid prescription limits | VA privatization fight heats up

View in your browser     Welcome to Overnight Health Care. Paul Ryan is retiring at the end of his term, John Boehner now supports the medical marijuana, and the Trump administration is weighing work requirements for welfare recipients. So, just a typical Wednesday.   Medicare advocates celebrated Ryan's announcement, noting that he will leave Congress without accomplishing his lifelong goal of reforming Medicare. "House Speaker Paul Ryan's retirement from Congress lifts a very dark cloud that has hung over older Americans for nearly two decades," Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare said in a statement. "During that time, Speaker Ryan has been the Privatizer-in-Chief on Capitol Hill – advocating to turn Medicare into a voucher program and to gamble retirees' Social Security benefits on the whims of Wall Street."   Meanwhile, the leader of the House Freedom Caucus said he doesn't blame Ryan for failing to enact entitlement reform. Rep. Mark Meadows (R-N.C.) said Congress lacks the political will to act on the issue that has long been one of Speaker Paul Ryan's (R-Wis.) goals. "To suggest that it [entitlement reform] didn't get done because of a lack of leadership on his part is not accurate," Meadows told reporters. "It's a lack of political will on everyone's part." For years, Ryan has been an outspoken proponent about the need to cut spending on Medicare, Medicaid and welfare programs as a way to trim the federal deficit. In a press conference Wednesday, Ryan said he's proud of "normalizing entitlement reform" and said he's going to keep fighting for it.   Try, try, try again.: The House this week is expected to vote on a constitutional amendment requiring the government to operate on a balanced budget, which Democrats say will result in drastic cuts to middle-class bedrocks, including Social Security, Medicare, and Medicaid. The measure though is unlikely to pass the Senate   Don't forget: Entitlement reform might be unlikely in Congress, but the Trump administration is looking at ways of implementing its own reforms. Read more here     Also on the hill, NIH Director Francis Collins said he would "aggressively" investigate reports that agency officials solicited funding from the alcohol industry for a study on the benefits of moderate drinking. The New York Times recently reported that NIH officials directly lobbied for donations from alcoholic beverage manufacturers to fund a study on the health effects of moderate alcohol consumption. "I am also very concerned about the materials that have been reported ... about these circumstances, which I agree are alarming," Collins said Wednesday during a congressional hearing on the NIH's budget request.   Why it matters: Public health advocates argue such an arrangement undermines public trust in the NIH. Read more here.   Combating the opioid crisis is a priority for states and health entities, but a new strategy to limit prescriptions is getting major pushback from doctors. The idea: curbing the amount of opioids that doctors can prescribe. These limits have garnered support from various stakeholders and are now being considered in Congress, with a bipartisan group of senators proposing to set a cap on first-time prescriptions for acute pain. Momentum for the policy has been building, and supporters of the opioid limits argue the measures are important to curb overprescribing, stem the volume of painkillers that could be diverted for illicit use and decrease a patient's potential to develop an addiction.   Hold on: The opioid limits have sparked opposition from the American Medical Association (AMA), the powerful physician lobby. It warns that the opioid rules are arbitrary and inhibit a doctor's ability to care for their patients on an individual basis. Read more here.   More on opioids: More Americans see opioid addiction as a significant issue in their communities than did two years ago, according to a new poll. Forty-three percent of Americans say the use of prescription pain drugs is an extremely or very serious problem in their communities, up from 33 percent two years ago, according to an Associated Press-NORC poll released Wednesday. We break it down here.   Democrats are gearing up for a fight over privatizing the VA. Trump's decision to oust former VA Secretary David Shulkin late last month and replace him with White House physician Ronny Jackson stoked speculation that the White House wants to allow veterans more access to private-sector health-care providers. The VA has denied this, essentially calling the idea fake news. But Democrats don't trust Trump, and they don't know anything about Jackson's views.   Looming clash: Expect the issue to be front and center when Jackson heads to his confirmation hearing. Jackson's nomination could also spotlight legislation that is intended to make it easier for veterans to get care outside the VA system without completely privatizing the system.   Sit tight: A spokeswoman for the VA committee said a hearing would be scheduled as soon as Jackson submits his paperwork and finishes a background check. Read more here.   Wednesday roundup The Arizona state House of Representatives passed a bill requiring women to provide the reason why they're obtaining an abortion. The American Civil Liberties Union (ACLU) is suing Kentucky over a law that bans one of the most common abortion methods in the U.S after 11 weeks. A bill signed into law by Gov. Matt Bevin (R) Tuesday bans dilation and evacuation, a method commonly used in second-trimester abortions, after 11 weeks of pregnancy. And a GOP lawmaker grilled Facebook founder and CEO Mark Zuckerberg on Wednesday over opioid dealers using the social media giant to distribute drugs.     What we're reading Mariah Carey reveals years-long battle with bipolar disorder (The Washington Post) Judicial nominee Wendy Vitter gets tough questions on birth control and abortion (NPR) Paul Ryan's most important legacy is Trump's war on Medicaid (Vox)   State by state Paying a penalty for no health insurance? Not in 13 Illinois counties. (Chicago Tribune) Study: Louisiana Medicaid expansion created 19,000 jobs (Nola.com) Haslam signs bill stripping TennCare funding from Planned Parenthood of Tennessee (Times Free Press)     Send tips and comments to Jessie Hellmann, jhellmann@thehill.com; Peter Sullivan, psullivan@thehill.com; Rachel Roubein, rroubein@thehill.com; and Nathaniel Weixel, nweixel@thehill.com. Follow us on Twitter: @thehill, @jessiehellmann, @PeterSullivan4, @rachel_roubein, and @NateWeixel.         Did a friend forward you this email? Sign up for Healthcare Newsletters     Forward Healthcare Newsletters       Privacy Policy  |  Manage Subscriptions  |  Unsubscribe  |  Email to a friend  |  Sign Up for Other Newsletters   The Hill 1625 K Street, NW 9th Floor, Washington DC 20006 ©2016 Capitol Hill Publishing Corp., a subsidiary of News Communications, Inc.